Male Circumcision | A Dangerous Mistake For HIV Prevention

Voluntary male circumcision (VMC) is being heavily promoted as a solution to halt the spread of HIV in sub-Saharan Africa. However male circumcision is a dangerous mistake in the fight against HIV.

There have been dozens of medical studies and clinical trials conducted in African countries in an effort to stem the AIDS pandemic. In only three highly controversial, short-term clinical trials, circumcision was purportedly shown to reduce risk of HIV transmission by 50–60% in heterosexual males engaging in male/female intercourse. The results did not show that females had any protection from HIV as a result their partners being circumcised, nor was transmission prevented in same sex partners. Drug use and other non-sexual vectors of HIV infection are not prevented by circumcision. The vast majority of other studies on the relationship between circumcision and HIV have shown either that circumcision offers no protection, or the results are inconclusive.

The trials were nearly identical in their methodology and in the number of men in each arm of the trial who became infected. The trials shared the same biases, which led to nearly identical results. All had expectation bias (both researcher and participant), selection bias, lead-time bias, attrition bias, duration bias, and early termination that favored the treatment effect the investigators were hoping for. All three studies were overpowered such that the biases alone could have provided a statistically significant difference.

The common hypothesis for these trials was that male circumcision would decrease the rate of heterosexually transmitted HIV infections. A basic assumption adopted by the investigators was that all HIV infections resulted from heterosexual transmission, so no effort was made to determine the source of the infections discovered during the trial. There is strong evidence that this assumption was not valid. In the three trials in Kenya, Uganda, and South Africa that are the basis for the HIV claims, the researchers assumed in their calculations they had 0% gay men in their studies.

It is important to note that Bailey failed in 2010 to find a protective effect in another study in Kenya. Also, in 2009 Gray saw a 50% higher male-to-female HIV transmission rate among the Ugandan men they circumcised.

Can this clinical research even be trusted? Some say clinical research is fraught with fraud as researchers and academics chase grant money.

Consider this quote from Dr. Marcia Angell; “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine” (Marcia Angell, “Drug Companies & Doctors: A story of Corruption”, NYRB, Jan 15, 2009). She shares some pretty sobering information in her book “The Truth About the Drug Companies”.

The ability to have unrestricted sex is the subtle message behind the African circumcision marketing campaigns. Meanwhile the drastic reduction in sensitivity caused by circumcision due to the loss of 20,000 penile nerve endings will make African men engage in riskier behavior to achieve sexual gratification. These factors can lead to an increase in unwanted pregnancies and higher rates of promiscuity. Pro-circumcision propaganda will decrease use of contraception.

In sub-Saharan Africa, it is estimated that 14 million unwanted pregnancies occur every year, with almost half occurring among women aged 15–24 years. (2. Williamson LM, Parkes A, Wight D, Petticrew M, Hart GJ. Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research. Reprod Health. 2009;6(3)doi:10.1186/1742-4755-6-3.)

Researchers from Johns Hopkins have a checkered history on ethics violations and outright racism.

Some of the leading researchers in the African circumcision/HIV trials are based out of the Johns Hopkins School of Public Health. However there have been disturbing incidents involving researchers from Johns Hopkins past that are cause for concern. For instance, during the infamous Tuskegee experiments on black Americans, Dr. Joseph E. Moore of Johns Hopkins University School of Medicine proposed that “Syphilis in the negro is in many respects a different disease from syphilis in whites.”

Johns Hopkins researchers conducted further racist research on blacks when they conducted their lead paint study in Baltimore. Using poor black children as guinea pigs, they exposed them to “dangerous lead hazards” during a 1990’s housing study. The US Department of Health and Human Services halted all federally funded medical research at Johns Hopkins involving human subjects after a similar investigation into a Hopkins asthma study that resulted in the death of a healthy volunteer.

Recent studies both in Africa and elsewhere examining circumcision rates and HIV prevalence found that circumcision did not significantly affect HIV infections.

Another 2008 study found that circumcision made no difference in HIV rates in South Africa. Connolly C, et al. Male circumcision and its relationship to HIV infection in South Africa: Results of a national survey in 2002. S Afr Med J 2008;98:789–94.A 2007 study concluded that, once commercial sex-worker patterns are factored in, male circumcision is not significantly associated with lower HIV. Talbott JR. Size Matters: The number of prostitutes and the global HIV/AIDS pandemic. PloS One. 2007;2(6): e543.

A just released report from the Zimbabwe Health Demographic Survey found that circumcised Africans had a higher (14%) HIV infection rate than Africans left intact (12%.) Read the article.

Researchers in Uganda say circumcision only reduces HIV transmission by 1.3% – not 60% as claimed in previous clinical trials. Basing on a recent male-to-female transmission of HIV study in Uganda, researchers Gregory Boyle and George Hill in a study published by Australia’s Thomson Reuters showed that more women contracted the virus after unprotected intercourse to infected circumcised male partners.Read the article

A study in Puerto Rico found, “Male circumcision may not make much difference to overall male HIV incidence in Caribbean context.” Researchers concluded, “a blanket roll-out of an MMC (Medical Male Circumcision) program in the context of a Caribbean country such as Puerto Rico would not necessarily make much difference to HIV prevalence in men as a whole.” Rodriguez-Diaz CE et al. More than foreskin: circumcision status, history of HIV/STI, and sexual risk in a clinic-based sample of men in Puerto Rico. Journal of Sexual Medicine, early online publication. doi: 10.1111/j.1743-6109.2012.02871.x, 2012. Read the abstract here.

Circumcision makes no difference to HIV infection in UK gay men: An analysis of an online and gay-venue survey of white, British-born, gay and bisexual men in the UK has found no association between whether they were circumcised and whether they had HIV. Doerner R et al. Circumcision and HIV infection among men who have sex with men in Britain: the insertive sex role. Archives of Sexual Behavior, early online edition, DOI 10.1007/s10508-012-0061-1, 2013. Read the abstract here.

A study in Israel showed that the HIV rate skyrocketed 55% between 2005 – 2012. Between 1981 through the end of 2011, there were 6,579 people in Israel who were diagnosed as having HIV or full-blown AIDS. Of this total, only 1,265 were homosexual men. That means 5314 heterosexual circumcised men contracted HIV leading to this stunning increase. Authorities attribute the increase to more people having unprotected sex, and lack of fear of the disease. Since Israeli men are all circumcised, it would be logical to assume their willingness to engage in unprotected sex was in part due to the widely publicized belief that circumcision offers protection. Read the story here. Furthermore, Israel has a much higher HIV infection rate than Japan, where in Japan most men are intact.

The New York Times reports that the infection rates in Uganda from 2005-2012 have increased while the United States, through its AIDS prevention strategy known as PEPFAR, or the President’s Emergency Plan for AIDS Relief, spent $1.7 billion in Uganda to fight AIDS. The results raise questions about the efficacy of a U.S. strategy largely based on circumcision. Read the article

The HIV virus can attack the mucosa at the meatus (urethral opening) or inside the urethra just as easily as the foreskin. So then the question arises, how much surgical cutting do we do to eliminate mucosal tissue from the penis? The only way to eliminate the mucosal tissue would be to eliminate the penis! Most men of sexually active age in the United States are already circumcised, but the HIV infection rates are higher in the USA than in other developed countries where circumcision is rare. Even common sense tells us the circumcision is unreliable in protecting against HIV.

Male Circumcision Endangers Women

Circumcision of HIV-infected men did not reduce HIV transmission to female partners over 24 months; longer-term effects could not be assessed.
(Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. (Lancet. 2009 Jul 18;374(9685):229-37. doi: 10.1016/S0140-6736(09)60998-3.

Circumcision can increase the risk to women if sex is resumed before the wound has completely healed. (Wawer M, Kigozi G, Serwadda D, et al. Trial of male circumcision in HIV+ men, Rakai, Uganda: effects in HIV+ men and in women partners. 15th Conference on Retroviruses and Opportunistic Infections. 3-6 February 2008. Boston. Abstract 33LB.)

Male circumcision also places women at greater risk of unsafe sex practices if they or their circumcised male partners wrongly believe they are immune to HIV. Female partners may become less insistent on use of condoms when they believe circumcision offers protection. Men who “had the cut” can become more aggressive in their demands for sex because they believe they are immune from HIV infection.

What has been proven to work in preventing the spread of sexually transmitted HIV?

Condom promotion and safe-sex education have already been shown to reduce infection rates more effectively for both males and females, at a lower cost. Furthermore, anti-retroviral drugs have shown a promising 92% reduction in HIV transmission.Stopping the spread of HIV requires using available resources strategically, and circumcision’s costs and harms are too significant to ignore. Mass circumcision campaigns will divert resources from proven prevention programs, result in a high number of complications, increase risk-compensation behaviors, and put women at higher risk for HIV.

SIGN THE PETITION TO STOP EXPLOITATION OF AFRICANS WITH CIRCUMCISION PROGRAMS.

U.S. medical researchers have a sordid history of unethical practices with STD experiments on black people, and others in undeveloped countries. Those promoting African circumcision seem to be more interested in obtaining grants & research money to promote circumcision than promoting effective methods such as education, condoms, and anti-retroviral therapy (ART).

Further proof of how US medical researchers exploit black people has been shown by the following incidents:

The infamous case of the Tuskegee experiments in which black men infected with syphilis were left untreated to see how they pass infections to others. The research on these black Americans was conducted by the U.S. Public Health Service (PHS). The discovery of the fact that the incidence of the disease was higher among African-Americans than among whites was attributed by some to social and economic factors, but by others to a possible difference in susceptibility between whites and non-whites. Indeed one Public Health Service consultant, Dr Joseph E. Moore of Johns Hopkins University School of medicine proposed that “Syphilis in the negro is in many respects a different disease from syphilis in whites.”

Researchers from Johns Hopkins are involved with the highly publicized African HIV trials.

Another notorious case involves U.S. government medical researchers that intentionally infected hundreds of people in Guatemala, including institutionalized mental patients, with gonorrhea and syphilis without their knowledge or permission. Doctors infected soldiers, prostitutes, prisoners and mental patients with syphilis and other sexually transmitted diseases, without the informed consent of the subjects. Experts from Harvard, Johns Hopkins, and the Universities of Pennsylvania and Rochester gave advance approval of the experiments which led to the death of at least 83 people. Read the story here. In 2010, Secretary of State Hillary Clinton officially apologized to the Guatemalan people.

American researchers are now using the same racist theories and pseudo-scientific experiments on Africans. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Clinton Foundation, and the Gates Foundation are on a misguided mission of African exploitation. We need to tell them……..

I fully support the end of this absolute violation on the male body. The hypocrisy of standing up to the horror of female genital cutting while funding and promoting the cutting of male genital cutting is grotesque. That this has not been seen as the hypocrisy that it is calls much into question.

Just saying there’s this international study worth understanding as well:

Stopping clinical trials early often exaggerates treatment effects

Date: March 24, 2010
Source: Mayo Clinic
Summary: An international study of nearly 100 clinical trials that were stopped early due to positive treatment effects has found that many of those effects were exaggerated.
—————————————————————————————

An international study of nearly 100 clinical trials that were stopped early due to positive treatment effects has found that many of those effects were exaggerated. The authors of the study — published in the current issue of the Journal of the American Medical Association — recommend that researchers resist pressures to end clinical trials early and continue trials for longer periods before even considering premature termination.

“Our research shows that in most cases early stopping of clinical trials resulted in misleading estimates of treatment effects. These misleading estimates are likely to result in misguided decisions about the trade-off between risks and benefits of a therapy,” says Victor Montori, M.D., Mayo Clinic endocrinologist and corresponding author of the study. “On average, treatments with no effect would show a reduction in relative risk of almost 30 percent in stopped early trials. Treatments with a true relative risk reduction of 20 percent would show a reduction of over 40 percent.”

The clinical trials that Dr. Montori and colleagues studied were ended early because of a convincing — and usually large — apparent difference between an experimental treatment and an existing standard therapy. The studies were ended so participants taking a placebo or less effective medications could also take the studied drug. It usually also allows physicians to prescribe the therapy sooner because it will reach the market earlier. Dr. Montori says almost everyone involved benefits from a trial ending early — doctors, researchers, funding sources, pharmaceutical firms, scientific journals, even reporters — everyone except the patient, who may end up receiving a therapy on the basis of misleading information about its benefits.

The researchers examined 63 medical questions regarding 91 truncated trials and compared them to 424 comparable trials that were not stopped early. Results showed that the studies that were stopped — especially smaller trials of a few hundred participants — had exaggerated or misleading treatment effects. Those misleading findings are often compounded downstream because researchers are less likely to return to the topic after what is perceived as a significant successful finding.

The authors recommend that researchers use restraint and truncate clinical trials only near the end of a study and then only with “a very good reason.” Otherwise, says Dr. Montori, patients and physicians will be making treatment choices based on inaccurate information, or worse, opting for one treatment when another may be more appropriate.

The study was supported by the Medical Research Council of the U.K. Other authors include Dirk Bassler, M.D.; Matthias Briel, M.D.; Qi Zhou, Ph.D.; Stephen Walter, Ph.D.; Gordon Guyatt, M.D.; and Diane Heels-Ansdell, all of McMaster University, Ontario; Melanie Lane, Mayo Clinic; and Paul Glasziou, M.B.B.S., Ph.D., University of Oxford, England.

Story Source:

The above story is based on materials provided by Mayo Clinic. Note: Materials may be edited for content and length.